Prevention of Post Partum Hemorrhage After Labor Induction Clinical Trial
Official title:
Effect of Misoprostol in Reducing Post Partum Hemorrhage After Labor Induction by Oxytocin: a Prospective Randomized Controlled Trial
The use of Oxytocin for labor induction may cause receptor exhaustion and thus making its use in the third stage of labor ineffective in reducing post partum blood loss as compared to other uterotonics.So, we studied the effect of other uterotonic which is misoprostol in reducing post partum hemorrhage.
Our study will be carried out at Makassed General Hospital, a tertiary-level maternity unit
performing about 1000 deliveries annually. After approval by the hospital Ethics and Research
Committee, women with single viable pregnancy, in cephalic presentation, at full term and
whom labor was induced by Oxytocin will be eligible for inclusion.
After informed consents is obtained, the parturients will be assigned randomly according to a
computer generated sequence in block lists of 25each time to receive either 1000mcg of
Misoprostol rectally or 20 units of Oxytocin intravenously to run at a rate of 150ml/hr. The
medications will be given just after cord clamping and before delivery of the placenta.
Active management of the third stage of labor will be carried out simultaneously with early
cord clamping, gentle downward traction of the placenta to hasten its delivery, and uterine
massage in addition to the uterotonic according to assignment of the patient. Assessment of
the uterine condition will be done by the obstetrician or his assistant, together with
visually estimating the amount of blood loss. Once uterine atony or estimated blood loss
(EBL) of more than 500 ml is noticed, another uterotonics will be administered according to
the condition and at the discretion of the obstetrician.
Failure to achieve adequate uterine contraction and to control post partum hemorrhage (PPH)
by the routine uterine massage will urge the use of either different uterotonics or surgical
intervention if necessary. Blood transfusion will be ordered for the cases whose visual
estimation of blood loss is more than 1000ml or when the patient was hemodynamically
unstable. In order to compare the effect of each medication alone on the amount of blood
loss, we will then exclude those patients who received blood transfusion or additional
uterotonics. A base line hemoglobin and hematocrit levels will be withdrawn on admission and
another reading 12 hours postpartum.
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